Serum Albumin Levels Research Articles

Unsupervised machine learning clustering approach for hospitalized COVID-19 pneumonia patients

BackgroundIdentification of distinct clinical phenotypes of diseases can guide personalized treatment. This study aimed to classify hospitalized COVID-19 pneumonia subgroups using an unsupervised machine learning approach.MethodsWe included hospitalized COVID-19 pneumonia patients from July to September 2021. K-means clustering, an unsupervised machine learning method, was performed to identify clinical phenotypes based on clinical and laboratory variables collected within 24 hours of admission. Variables were normalized before clustering to ensure equal contribution to the analysis. The optimal number of clusters was determined using the elbow method and Silhouette scores. Cox proportional hazard models were used to compare the risk of intubation and 90-day mortality across the identified clusters.ResultsThree clinically distinct clusters were identified among 538 hospitalized COVID-19 pneumonia patients. Cluster 1 (N = 27) consisted predominantly of males and showed significantly elevated serum liver enzymes and LDH levels. Cluster 2 (N = 370) was characterized by lower chest x-ray scores and higher serum albumin levels. Cluster 3 (N = 141) was characterized by older age, diabetes mellitus, higher chest x-ray scores, more severe vital signs, higher creatinine levels, lower hemoglobin levels, lower lymphocyte counts, higher C-reactive protein, higher D-dimer, and higher LDH levels. When compared to cluster 2, cluster 3 was significantly associated with increased risk of 90-day mortality (HR, 6.24; 95% CI, 2.42–16.09) and intubation (HR, 5.26; 95% CI 2.37–11.72). In contrast, cluster 1 had a 100% survival rate with a non-significant increase in intubation risk compared to cluster 2 (HR, 1.40, 95% CI, 0.18–11.04).ConclusionsWe identified three distinct clinical phenotypes of COVID-19 pneumonia patients, with cluster 3 associated with an increased risk of respiratory failure and mortality. These findings may guide tailored clinical management strategies.

Mortality Risk Prediction in Patients With Antimelanoma Differentiation-Associated, Gene 5 Antibody-Positive, Dermatomyositis-Associated Interstitial Lung Disease: Algorithm Development and Validation.

Patients with antimelanoma differentiation-associated gene 5 antibody-positive dermatomyositis-associated interstitial lung disease (anti-MDA5+DM-ILD) are susceptible to rapidly progressive interstitial lung disease (RP-ILD) and have a high risk of mortality. There is an urgent need for a reliable prediction model, accessible via an easy-to-use web-based tool, to evaluate the risk of death. This study aimed to develop and validate a risk prediction model of 3-month mortality using machine learning (ML) in a large multicenter cohort of patients with anti-MDA5+DM-ILD in China. In total, 609 consecutive patients with anti-MDA5+DM-ILD were retrospectively enrolled from 6 hospitals across China. Patient demographics and laboratory and clinical parameters were collected on admission. The primary endpoint was 3-month mortality due to all causes. Six ML algorithms (Extreme Gradient Boosting [XGBoost], logistic regression (LR), Light Gradient Boosting Machine [LightGBM], random forest [RF], support vector machine [SVM], and k-nearest neighbor [KNN]) were applied to construct and evaluate the model. After applying inclusion and exclusion criteria, 509 (83.6%) of the 609 patients were included in our study, divided into a training cohort (n=203, 39.9%), an internal validation cohort (n=51, 10%), and 2 external validation cohorts (n=92, 18.1%, and n=163, 32%). ML identified 8 important variables as critical for model construction: RP-ILD, erythrocyte sedimentation rate (ESR), serum albumin (ALB) level, age, C-reactive protein (CRP) level, aspartate aminotransferase (AST) level, lactate dehydrogenase (LDH) level, and the neutrophil-to-lymphocyte ratio (NLR). LR was chosen as the best algorithm for model construction, and the model demonstrated excellent performance, with an area under the receiver operating characteristic (ROC) curve (AUC) of 0.866, a sensitivity of 84.8%, and a specificity of 84.4% on the validation data set and an AUC of 0.90, a sensitivity of 85.0%, and a specificity of 83.9% on the training data set. Calibration curves and decision curve analysis (DCA) confirmed the model's accuracy and clinical applicability. Moreover, the model showed strong predictive performance in the external validation cohorts (cohort 1: AUC=0.836, 95% CI 0.754-0.916; cohort 2: AUC=0.915, 95% CI 0.871-0.959), indicating good generalizability. This model was integrated into a web-based tool to predict the 3-month mortality for patients with anti-MDA5+DM-ILD. We successfully developed a robust clinical prediction model and an accompanying web tool to estimate the 3-month mortality risk for patients with anti-MDA5+DM-ILD.

Associations between depressive and anxiety symptoms and incident kidney failure in patients with diabetic nephropathy

ObjectiveThis study aimed to analyze the associations between depressive and anxiety symptoms and risk of incident kidney failure in patients with biopsy-proven diabetic nephropathy (DN).MethodsThis retrospective study enrolled 241 type 2 diabetic patients with biopsy-proven DN. Huaxi Emotional-Distress Index (HEI) was used to evaluate the depression and anxiety status of patients on admission. According to the HEI score, DN patients were divided into HEI score ≤ 8 group (without depression and anxiety) and HEI score > 8 group (with depression and anxiety). The study endpoint was defined as progression to kidney failure. The cox proportional hazard analysis was performed to investigate the risk factors for progression to kidney failure in DN patients.ResultsTwenty-three patients had HEI score > 8, accounting for about 9.5% of all patients. Compared with HEI score ≤ 8 group, those with HEI score > 8 had more severe proteinuria, higher systolic blood pressure, and lower baseline eGFR and serum albumin levels. During a median follow-up of 28 months, the outcome event occurred in 89 (36.9%) of all the patients. After multivariable adjustment, HEI score > 8 (HR 1.825, 95% CI 1.050–3.172) was associated with an increased risk of progression to kidney failure.ConclusionDepressive and anxiety symptoms might be associated with an increased risk of progression to kidney failure in patients with DN, which implied psychosocial issues should be early screened, assessed and intervened to delay the progression of DN.

Clinical evaluation of platelet-to-albumin ratio as a predictor of surgical site infection in pediatric patients with ulcerative colitis.

This study explored the predictive factors for surgical site infection (SSI) in a pediatric ulcerative colitis (UC) population. Data from 35 patients with UC who underwent surgery before 15years at Mie University Hospital between January 2000 and December 2022 were retrospectively reviewed. Potential preoperative and intraoperative predictors of SSI, including various demographic and clinical variables, were analyzed using the Mann-Whitney U test and logistic regression analysis. The optimal cutoff value for the variables was determined by examining the receiver operating characteristic curve. Of the 35 patients, 8 (22.9%) experienced SSI. The platelet-to-albumin ratio (PAR) is a more accurate predictor of SSI occurrence than the serum albumin level, platelet count, or C-reactive protein level. The sensitivity and specificity of PAR were 75.0% and 77.8%, respectively, with an area under the curve (AUC) of 0.782 (p = 0.018). A multivariable analysis revealed that preoperative PAR was the only significant independent predictor (cutoff value: 115,000, p = 0.047) when the optimal cutoff value was applied rather than the median value. This study demonstrated the value of the preoperative PAR in the management of pediatric patients with UC. Assessing the patient's PAR before surgery allows proactive treatment to reduce the risk of SSI.

Factors Predicting Major Complications and Mortality in Percutaneous Endoscopic Gastrostomy: 8 Years of Experience of a Tertiary Surgery Center.

Percutaneous endoscopic gastrostomy (PEG) is a safe method of choice for patients who need long-term nutritional support. However, complications and high mortality rates have been reported. Based on 8 years of experience in tertiary care hospitals, we aimed to identify risk factors associated with major complications and 30-day mortality after PEG. Patients who underwent PEG in the General Surgery clinic of Tokat Gaziosmanpaşa University, Faculty of Medicine between January 2014 and March 2022 were included in the study. Data regarding patient demographics, comorbidities, laboratory data, drugs used together, and indications for PEG tube placement were collected. There were 429 patients. The mean age of the patients was 66.9±16.75 years, and 180 (44%) patients were female. The mean follow-up period was 8.84±6.75 months. Twenty patients (4.9%) had major complications. Female sex [Odds Ratio (OR) 0.33, 95% CI, CI=1.23-8.87, P=0.02] and diabetes mellitus (DM) (OR=0.23, 95% CI=1.93-6, P=0.002) were the independent variables associated with major complications. The all-cause 30-day mortality rate was 5.9% (n=24). Malignancy, DM, corticosteroid use, low albumin, and platelet values were associated with increased mortality in multivariate analysis as indications for PEG. Female sex and patients with DM may potentially face major complications. The patients with cancer, diabetes, and corticosteroid use were associated with higher mortality. In addition, low serum albumin and platelet levels were an effective factor for survival in patients undergoing PEG, and this should be taken into account in decision-making.

Clinical and biochemical characteristics for patients with polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes syndrome: a pilot observational study

BackgroundPolyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes (POEMS) syndrome is rare life-threatening condition associated with a clonal plasma cell neoplasm.ObjectiveThe aim of this study is to investigate the clinical and biochemical features in patients with POEMS syndrome before and post-therapy.MethodsCharacteristics of demographic information, underlying diseases, clinical manifestations, laboratory indicators, and imaging examination were retrospectively collected when diagnosed and post-therapy in the patients POEMS syndrome between 2018 and 2024.ResultsNineteen newly-diagnosed, treatment-naïve patients with POEMS syndrome were enrolled. The diagnosis of POEMS syndrome was re-analyzed and matched the diagnostic criteria updated in 2023. All patients presented the symptoms of polyneuropathy and positive for M-protein. Most patients suffered with hyperpigmentation (n = 18), organomegaly (n = 18), elevated vascular endothelial growth factor (VEGF) (n = 17), extravascular volume overload (n = 15), sclerotic bone lesions (n = 11), and hypothyroidism (n = 10). Serum alanine aminotransferase, aspartate aminotransferase, total bilirubin, total protein, and albumin levels were down-regulated, while uric acid level was up-regulated in patients with POEMS syndrome. Reduced triiodothyronine, thyroxine, free triiodothyronine levels were negatively correlated with urea nitrogen, creatinine, and uric acid levels in patients with POEMS syndrome. VEGF level, which was negatively correlated with Ca2+ level (r = −0.56), was reduced in most patients with POEMS syndrome receiving bortezomib/ixazomib and lenalidomide/thalidomide therapy. Aspartate aminotransferase, total protein, and estimated glomerular filtration rate levels were increased, while creatinine and uric acid levels were reduced post-therapy in patients with POEMS syndrome.ConclusionPatients with POEMS syndrome had impaired liver and renal function, and effective therapy might partly repair the liver and renal dysfunction.

Lower time-averaged serum uric acid was associated with increased mortality in peritoneal dialysis patients.

The relationship between time-averaged serum uric acid (TA-SUA) levels and prognosis in peritoneal dialysis (PD) patients are rarely discussed. This was a retrospective cohort study. PD patients recruited from January 1, 2011, to December 31, 2020, were included. Baseline and follow-up uric acid levels over 1 year were collected to calculate time-averaged serum uric acid (TA-SUA) levels. Patients were divided into four groups based on TA-SUA quartiles: Q1 (<5.1 mg/dl), Q2 (5.1-5.8 mg/dl), Q3 (5.8-6.8 mg/dl), and Q4 (>6.8 mg/dl). A total 487 PD patients with a mean age of 52.0 ± 14.2 were enrolled, including114 (23.4%) diabetes. Q1 (n = 121, 24.8%), Q2 (n = 118, 24.2%), Q3 (n = 125, 25.7%), and Q4 (n = 123, 25.3%). The Q1 group exhibited characteristics of increased age, malnutrition, and a higher prevalence of diabetes. During the 48.1 months follow-up time, 197 (35.8%) died, 109 (55.3%) cardiovascular disease (CVD), 38 (19.3%) infections. Kaplan-Meier analysis revealed that both all-cause mortality and cardiovascular mortality were significantly higher in the Q1 and Q4 groups (log-rank = 24.373, p < 0.001). COX regression analysis showed that decreased TA-SUA level was an independent risk factor for all-cause mortality in PD patients after adjustment for confounding factors. Each 1 mg/dl decrease in TA-SUA level was associated with a 23.46% increase in all-cause mortality (HR = 0.81, 95% CI, 0.71-0.94; p = 0.004*). Lower serum albumin level was associated with increased all-cause mortality. PD patients with lower TA-SUA were older and had a higher proportion of diabetes and malnourishment than those with higher TA-SUA. Long-term exposure to low TA-SUA levels was an independent predictor of all-cause and cardiovascular mortality in PD patients.

The Assessment of Serum Cytokeratin 18 and Liver Function Tests in Chronic hepatitis B patients.

Background Chronic hepatitis is a clinical and pathological disorder, some biochemical testes like serum Alanine Amino-transferase (ALT), Aspartate Amino-transferase (AST) and total serum bilirubin (TSB) used to monitoring hepatitis diseases. Albumin levels in serum fall with liver disease progression, representing decreased synthesis. Prothrombin time evaluate the level of converted prothrombin to thrombin and this represent the synthetic function of the liver. In acute on chronic liver Disease non apoptotic pattern of cell death is predominant .It is confirmed by cleaved K18. Cytokeratin 18 was measured by ELISA Objectives: This study aimed to measure the ALT ,AST ,TSB, Albumin ,PT and K18 levels inthe serum of Iraqi patients who were having Liver disease And study the correlation between the variables mentioned above Materials and Methods: The study included approximately One hundred subjects, ages 20 to 60 year, who were split into two groups , Fifty patient with chronic hepatitisB virus,The second group comprises of 50 subjects who look to be in good health and serves as the control group. Results Serum levels of ALT, AST, TSB, PT and albumin displayed a significant increase in chronic hepatitis B virus group compare with control group . Also, the current study revealed non-significant association of liver function tests with different age groups, except total serum Bilirubin values decline significantly with increasing age, and there was a significant gender difference in AST concentration. While, there was non-significant gender difference in further liver parameters. Conclusion Among chronic hepatitis B patientin Babylon province, abnormality of liver function tests in different age and gender groups; indicat the significant linke with the development of chronic hepatitis B virus.

Serum hypoalbuminemia is an independent prognostic factor in Chronic Myelomonocytic Leukemia (CMML).

CMML is a heterogenous myelodysplastic/myeloproliferative neoplasm (MDS/MPN) sharing both diseases' molecular and clinical phenotypes. Several models are used to risk-stratify patients diagnosed with CMML. Inflammation plays a pivotal role in developing the disease or its progression and has been linked to worse outcomes. Serum albumin (SA) is an inflammatory marker and/or surrogate for co-morbidities. While the role of SA has been investigated in myelodysplastic syndrome (MDS), acute myeloid leukemia (AML), multiple myeloma, and other cancers, its prognostic value in CMML remains unclear. We identified 919 patients diagnosed with CMML with known SA levels at the time of diagnosis or prior to any therapy. We divided patients into three groups based on SA levels: < 3.5 g/dL, 3.5-4.0 g/dL and > 4.0 g/dL. We then compared the baseline characteristics and outcomes of these three groups. Patients with SA < 3.5 g/dL had higher risk disease according to the CPSS-Molecular model, WHO 2022 classification, and FAB classification. Additionally, patients with SA < 3.5 g/dL had a higher median blast percentage, ferritin levels, WBC, and monocyte count (P < 0.001). These patients were also more likely to be cytopenic and RBC transfusion-dependent (RBC-TD) (P < 0.001). In multivariable Cox regression analysis, SA was independently significant for predicting overall survival (OS) after adjusting for CPSS-Molecular risk, WHO 2022 subtype, proliferative CMML (FAB classification), RBC-TD, and bi/pancytopenia. Therefore, SA is an independent prognostic factor for OS among patients with CMML. Low SA may reflect inflammatory disease status or a surrogate for co-morbidities. Risk stratification models should incorporate serum albumin levels to refine their prognostic value.

Analysis of Outcomes and Factors Influencing Community-Acquired Pressure Injury: A Retrospective Review of 413 Patients.

The purpose of this study was to analyze the outcomes and influencing factors of patients with community-acquired pressure injuries (CAPIs) and provide insights for clinical practice. Retrospective cohort study. We reviewed medical records of 413 patients with a total of 522 CAPIs. Patients with CAPIs who were hospitalized at Mianyang Central Hospital, Sichuan Province, China, between December 2021 and December 2022. Depending on CAPI outcome at the time of discharge, the patients were split into "improvement" and "no improvement" groups. Factors influencing CAPI outcomes were examined using univariate analysis followed by multivariate analysis (logistic regression). A majority of patients (n=324, 78.5%) showed improvement, and 89 (21.5%) showed no improvement. Logistic regression analysis showed statistically significant associations between CAPI outcomes and Braden Scale for Pressure Sore Risk scores, Barthel Index for Activities of Daily living scores, along with serum albumin, hemoglobin, interleukin-6, and C-reactive protein levels. The outcomes of patients with CAPIs were influenced by the Braden score, the Barthel score, serum albumin and hemoglobin levels, as well as inflammatory markers, including interleukin-6 and C-reactive protein. To effectively treat and care for patients with CAPIs, nurses should develop customized nursing interventions based on the unique characteristics of patients.

Risk factors for venous thromboembolism in patients undergoing neoadjuvant chemotherapy as treatment for ovarian cancer.

During the treatment of ovarian cancer, the risk of venous thromboembolism (VTE) post operatively is well established, however, patients may be at even greater risk during neoadjuvant chemotherapy (NACT). This study aimed to determine the incidence and timing of VTE amongst patients undergoing NACT, whether there was an association with survival, and examine risk factors associated with the development of VTE. This was a retrospective cohort study of patients diagnosed with ovarian, fallopian tube and primary peritoneal cancer receiving neoadjuvant chemotherapy betweenApril 2011 and April 2022 at a gynaecological cancer centre in England. Clinical factors examined included: age at diagnosis, Body Mass Index (BMI), presence of inflammatory co-morbidity, tumour morphology, stage of disease, pelvic mass,ascites,retroperitoneal lymphadenopathy, Khorana score, serum albumin levels, chemotherapy regime, bevacizumab administration and Ca 125 levels. Of 304 patients analysed, 73 (24%) patients developed venous thromboembolism. Of the patients who developed VTE, fifty-five patients developed pulmonary embolism (75%) and the stage of treatment at which most VTEs were diagnosed was neoadjuvant chemotherapy (32%). There was no correlation observed, between the incidence of VTE and any risk factors, including Khorana score, with the exception of low albumin (<35g/L)(odds ratio (OR):2.1(95%CI 1.1-3.9; p=0.06) and patients who did not receive paclitaxel chemotherapy (OR:2.04(95%CI 1.02-4.05; p=0.08). There was no difference in survival rates between the VTE group and the non-VTE group. This study demonstrates high rates of VTE, especially pulmonary embolism, in ovarian cancer patients undergoing NACT. The present study, amongst others in the literature also suggest that the risk of VTE in ovarian cancer patients undergoing NACT is underestimated by current risk stratification models. Therefore, prospective trials dedicated to ovarian cancer patients specifically, and a development of a risk model that takes into account factors established by higher levels of evidence, are strongly recommended.

The efficacy of anamorelin in gastrointestinal cancer with cancer cachexia: Single center experience.

815 Background: Cancer cachexia is a catabolic syndrome that causes weight loss and loss of appetite in cancer patients. Anamorelin (ANAM) is an oral drug approved in Japan to treat cancer cachexia by selectively activating ghrelin receptors. There is limited real-world data available on the efficacy of ANAM for patients with gastrointestinal cancer. We assessed its efficacy and identified associated clinical features. Methods: We retrospectively collected data from medical records and questionnaires on gastric and colorectal cancer patients who received ANAM between April 2021 and March 2023. We evaluated the change in body weight, appetite, and oral intake from the time of initiation of ANAM. We judged the responder who gained more than 0.5 kg in body weight, improved appetite, and increased oral intake, respectively. The association between clinical features and the responders was also assessed using multivariate logistic regression analysis. Results: 72 patients were included in this study. Characteristics of the patients: median age: 68 years old (range 38-85), male/female: 35/37, gastric/colorectal cancer: 39/33, PS 0-1/2 or more: 63/9, median body mass index (BMI): 18.0 kg/m 2 (range 12.3-27.9), number of prior chemotherapy regimens 1/2/3 or more: 17/22/33, ascites none/mild/moderate/severe: 42/19/7/4, median serum albumin levels (Alb): 3.2 g/dl (range 2.0-4.2). The median treatment duration of ANAM was 47.5 days (3-450 days). 57 patients (79.2%) continued ANAM for more than 3 weeks, and 9 patients for more than 12 weeks. The main reasons for discontinuation were progressive disease (39.7%), ineffective (12.7%), effective (11.1%) and adverse events of ANAM (11.1%). 33 patients (45.8%) gained weight, 41 patients (56.9%) improved appetite and 34 patients (47.2%) increased oral intake. There was a correlation found between BMI ＜ 18.0 kg/m 2 and the responders (OR 3.43, p = 0.041). Conclusions: In this study, 68.0% of patients who received ANAM for showed response, that is, gained body weight, or improved appetite, or increased oral intake. And these observations suggested that BMI was associated with effects of ANAM. Further studies involving more patients needed.

Risk Factors for Incontinence-Associated Dermatitis in Adults: A Systematic Review and Meta-Analysis.

A meta-analysis was conducted to comprehensively identify risk factors of incontinence-associated dermatitis (IAD) in adults and provide evidence-based support for healthcare professionals to formulate IAD preventive interventions and bundled interventions. Systematic review and meta-analysis of pooled findings. Two researchers independently searched databases PubMed, EBSCO, Cochrane Library, Embase, Medline, Web of Science and Scopus and 4 Chinese databases (CNKI, Wanfang Data, VIP and CBM) for relevant studies published from their inception to March 15, 2023. Two researchers independently extracted relevant data and literature characteristics and evaluated the quality of the included studies. Twenty-seven studies that collectively enrolled 4046 participants were included in our systematic review. Five were written in English, 1 was written in Spanish, and the other 21 were written in Chinese. The odds ratios (ORs) and 95% confidence intervals (CIs) of the risk factors for IAD were determined. Fecal incontinence, an etiologic factor (OR=5.79; 95% CI=[1.88-17.87]), stool characteristics (OR=5.28; 95% CI=[2.51-11.07]), and daily frequency of bowel movements (OR=5.76; 95% CI=[4.48-7.42]) were associated with an increased likelihood of IAD. The following risk factors: fever (OR=4.23; 95% CI=[1.89-9.46]), age (OR=1.04; 95% CI=[1.01-1.09]), hypoproteinemia (OR=3.30; 95% CI=[1.90-5.72]), impaired consciousness (OR=2.43; 95% CI=[1.66-3.54]), days of antibiotic use (OR=4.13; 95% CI=[3.11-5.49]), diabetes mellitus (OR=2.90; 95% CI=[1.73-4.86]), and a higher overall Perineal Assessment Tool (PAT) score (OR=2.56; 95% CI=[1.23-5.30]) emerged as independent risk factors for IAD in adult patients. In contrast, a higher serum albumin level (OR=0.88; 95% CI=[0.84-0.93]), a higher Braden Scale for Predicting Pressure Score Risk (Braden Scale) score (OR=0.66; 95% CI=[0.56-0.77]), and a higher Braden Scale mobility subscale score (OR=0.86; 95% CI=[0.74-1.00]) were protective factors that reduced the likelihood of IAD. Identification of risk factors for IAD may be used to identify patients at risk and in need of preventive interventions. Identification of modifiable risk factors may be used to design novel preventive interventions.

Correlation of the Geriatric Nutritional Risk Index (GNRI) With Other Indicators of Nutrition in Chronic Hemodialysis Patients.

The GNRI (Geriatric Nutritional Risk Index1) is an index used in geriatrics to predict the risk of complications and mortality associated with malnutrition. It considers serum albumin levels and the ratio of current weight or BMI to the ideal theoretical weight/BMI. The aim of this study was to evaluate this index in a population of metabolically stable chronic hemodialysis patients aged > 60 years and associate it with other nutritional markers. The studied patient cohort was divided into two groups based on their Geriatric Nutritional Risk Index (GNRI) scores: Gr 1 with GNRI score < 97 and Gr 2 with GNRI ≥ 97. We registered the anthropometric, clinical, and biological data of the study population. One hundred seventy-seven patients (102 M-75F) undergoing chronic hemodialysis were included. There were no differences in age, muscle mass estimated by bioimpedance analysis, potassium levels, phosphorus levels, and nPCR between the groups. However, there were significant differences between the two groups concerning the primary disease. Gr 1 presented with a higher prevalence of diabetes and cardiovascular comorbidities. Additionally, Gr 1 presented with lower handgrip strength (Mean ± standard deviation in kg, 19.79 ± 9.37 vs. 26.83 ± 11.63, p = 0.05), lower fat mass index estimated by bioimpedance analysis (Mean ± standard deviation in kg/m2, 7.31 ± 4.55 vs. 15.24 ± 6.47, p < 0.001), and higher CRP levels (Mean ± standard deviation in mg/l, 22.27 ± 23.49 vs. 8.13 ± 10.14, p < 0.001). In conclusion, the GNRI, an easy calculation tool for nutrition assessment, is associated with important nutritional status parameters in chronic hemodialysis patients.

Clinical value analysis of integrated care model in reducing bleeding and complications during Da Vinci robot-assisted urology.

This study aims to explore the effect of integrated care mode on patients in Da Vinci robot-assisted urology surgery and provide a new nursing scheme for clinic. A total of 93 patients from August 2022 to March 2024 were selected and divided into intervention group (43 cases) and control group (50 cases). The operation time, blood loss, first postoperative exhaust time, time to get out of bed, pain score (visual analog scale), psychological status (self-rating anxiety scale and self-rating depression scale), quality of life score (36-Item Short Form Survey), catheter retention time, patient satisfaction, incision healing, incidence of urinary system infection, nutritional status, and complication rate were compared between the 2 groups. There were no significant differences in baseline data and operative time between the 2 groups (P > .05), but the amount of intraoperative blood loss in the intervention group (250.32 ± 50.23) mL was less than that in the control group (320.56 ± 65.34) mL (P < .05). The first postoperative exhaust time and getting out of bed time in the intervention group were shorter than those in the control group (P < .05), and the pain visual analog scale score was lower than that in the control group (P < .05). The scores of self-rating anxiety scale and self-rating depression scale of mental state were better than those of the control group (P < .05), and the scores of quality of life were higher (P < .05). The retention time of catheter was shorter than that of the control group (P < .05), the patient satisfaction was 93.02% higher than that of the control group 78.00% (P < .05), and the grade A incision healing rate was 90.70% higher than that of the control group 76.00% (P < .05). The incidence of urinary system infection (4.65%) was lower than that of the control group (16.00%) (P < .05), the changes of serum albumin level and body weight were lower than that of the control group (P < .05), and the complication rate of 6.98% was lower than that of the control group (22.00%) (P < .05). Although the integrated medical care model did not significantly shorten the operation time, it was beneficial to the postoperative recovery of patients in many aspects.

Improving hemodialysis patient depression outcomes with acupuncture: A randomized controlled trial.

To evaluate the efficacy and safety of acupuncture as a supplementary treatment for mild to moderate depression in hemodialysis patients. This multicenter, randomized, controlled, single-masked trial included 64 hemodialysis patients aged 18-75 divided into two groups. One group received genuine acupuncture, while the other received sham acupuncture over 12weeks. The primary outcome measure was Hamilton Depression Scale (HAMD) scores; an inclusion criterion was HAMD scores of 10-23. Secondary outcomes included life quality improvements and changes in biochemical markers, such as serum albumin and hemoglobin levels. To assess the predictive effects of acupuncture treatment and biochemical parameters on depressive symptoms, a multivariable linear regression analysis was conducted. Following acupuncture treatment, HAMD scores significantly decreased, quality of life scores improved, and biochemical indicators (serum albumin, hemoglobin, transferrin, and total protein levels) showed some improvement, indicating the effectiveness of acupuncture in alleviating depressive symptoms and enhancing overall health in hemodialysis patients. Multivariable regression analysis showed that acupuncture treatment (P=0.004) and serum albumin levels (P=0.03) were significant predictors of improvement in depressive symptoms, with an adjusted R2 of 0.45, indicating that the model explained 45% of the variance in symptom improvement. Other biochemical indicators, such as hemoglobin, transferrin, and total protein, did not show significant predictive effects (P>0.05). No serious adverse events were observed during the treatment. Acupuncture is a safe and effective adjunct therapy for alleviating mild to moderate depression in hemodialysis patients. Acupuncture treatment and certain biochemical indicators (such as serum albumin) have significant predictive value for improving depressive symptoms.

Prognostic significance of left atrial volume index in patients with severe aortic stenosis after transcatheter aortic valve

Abstract Background Transcatheter aortic valve replacement (TAVR) is an important approach for patients with severe aortic stenosis (AS), but its mortality remains high and its prognostic factors are not fully understood. Methods This single-center retrospective cohort study enrolled 553 consecutive severe AS patients who underwent TAVR between April 2012 and October 2019. Patients with biological valve decay after surgery, moderate to severe mitral stenosis, and inadequate echocardiographic image were excluded. The primary outcome was mortality at 4 years after TAVR. Results Over the follow-up time, 64 patients (12.8%) died. Compared to the Survivors, the Non-survivors were older, less females, higher STS scores, larger left atrial volume index (LAVi) and lower serum albumin level. Results from univariate and multivariate cox regression analysis showed that the age (HR, 1.072; 95% CI 1.023-1.124, p =0.004), the LAVi level (HR, 1.023; 95% CI 1.013-1.033, p &amp;lt;0.001) and the serum level of albumin (HR, 0.862; 95% CI 0.796-0.934, p &amp;lt;0.001) were the independent risk factors for estimation of 4-year mortality after TAVR. Moreover, the mortality in patients with the highest category of LAVi (&amp;gt;48 ml/m2) was significantly higher than others, and its multivariable HR was 4.796 (95% CI, 1.137-20.238). In addition, Kaplan-Meier analysis revealed a reduced survival probability according to the highest category of LAVi (p =0.003). Conclusion LAVi was an independent predictor of mortality in patients with severe AS after TAVR, and LAVi could be used as a risk stratificationtool for long-term clinical outcome of post-TAVR patients.

P-1940. Low Visceral Fat Volume and Hypoalbuminemia as Prognostic Markers in Hospitalized Patients with COVID-19 During the Omicron Variant Epidemic

Abstract Background The rate of severe cases of coronavirus disease 2019 (COVID-19) has decreased since the Omicron variant became epidemic. Visceral fat volume was a risk factor for COVID-19 severity with prior prevalent variants, but whether visceral fat volume remains a risk factor for the Omicron variant is unclear. We investigated the associations of clinical factors including visceral fat volume with severity and mortality among hospitalized patients with COVID-19 during the Omicron variant epidemic.Table 1.Multivariable analysis of clinical factors associated with COVID-19 severity. Methods We included hospitalized patients with COVID-19 during the Omicron variant epidemic who underwent computed tomography of the abdomen. Clinical data were obtained from the medical records and visceral fat area (VFA) was measured using a 3-dimensional image analysis system volume analyzer. Severity was determined by the presence or absence of oxygen supplementation.Table 2.Multivariable analysis of clinical factors associated with mortality in hospitalized 206 patients with COVID-19. Results Among the 226 patients, 66 patients showed moderate severity and 29 patients were non-survivors. Hypoalbuminemia was associated with severity (odds ratio [OR] 3.93, 95% confidence interval [CI] 1.91–8.07; p=0.0002)(Table 1), and hypoalbuminemia (OR 8.38, 95%CI 2.37–29.58; p=0.0010) and low VFA (OR 3.40, 95%CI 1.15–10.06; p=0.027) were associated with mortality (Table 2). Decision tree analysis showed that mortality rate in the hypoalbuminemia and low-VFA group (37.3%) was significantly higher than in other groups (p&amp;lt; 0.01)(Fig.1).Fig 1.Decision tree analysis of patient mortality rates classified by serum albumin level and visceral fat area.Patients were initially classified with a cutoff value of 3.5 g/dL for serum albumin, then classified into four groups using a cutoff value of 100 cm² for visceral fat area. Conclusion Low visceral fat volume and hypoalbuminemia were associated with mortality in hospitalized patients with COVID-19 during the Omicron variant epidemic. Classification by VFA and serum albumin may allow simple prediction of mortality risk among hospitalized patients with COVID-19. Disclosures All Authors: No reported disclosures

P-2178. Can serum ferritin be used as a marker of severity in dengue fever?: a prospective observational study from North India

Abstract Background Dengue has a variable clinical course and there is no standardised marker for predicting dengue severity. Studies have shown higher ferritin levels in dengue compared to other febrile illnesses. Prospective studies to show correlation of ferritin with dengue severity are lacking. Demographic profile and workflow From 134 patients 99 were selected for the study , 35 were excluded as per the exclusion criteria (figure 1 flowchart). Majority of the patients were young (figure 3) with male predominance (figure 2), the male female percentages and age did not vary significantly across different grades of severity (table1 and figure 4). Methods Single centre prospective observational study conducted over 2 years. Patients of chronic inflammatory diseases, thalassemia, haematological malignancy or severe anemia (Hb &amp;lt; 7gm/dl) were excluded. Two ferritin samples 3 days apart measured by automated BECKMAN COULTER DxI.800 immunoassay analyzer. Clinical features and median ferritin value across different dengue severties In Figure 5 the pie chart shows that majority of the patients were dengue without warning signs , approximately 1/5th were severe dengue. Figure 6 shows that initial clinical features were more or less similar in the three groups of severities , however bleeding, pain abdomen , vomiting were more common in severe dengue group. Table 2 showing median ferritin values of day 0 and day 3 ferritin in different severity groups and whether their differences are statistically significant between each groups or not. The Box and whisker plots in figure 7, 8 and 9 shows the same with corresponding p values and Median ferritin level annotated. Results Total study population was 99 patients with median age of 28 years (24.5-34.5) and male predominance (68%). 2009 WHO classification wise 43% were dengue without warning signs 36% dengue with warning signs and 21% were severe dengue patients. Both day 0 and day 3 ferritin median value were higher across all three groups and the difference were statistically significant (p=0.00002 and p=0.045 respectively). Day 0 ferritin median value difference was statistically significant between severe dengue and dengue without warning sign (0.00001) and warning sign group (p=0.0003). In case of early ferritin sample (within day 7 of illness) it was significantly different between all groups. Serum ferritin also showed strong positive correlation with AST, ALT and negative correlation with Albumin levels. ROC curve analysis showed that a ferritin cut off of 9185 ng/ml with AUC 0.811, standard error 0.06 and 95% CI of 0.69-0.92 could differentiate severe from non severe dengue with 52.4% sensitivity and 97.4% specificity. For early ferritin sample cut off becomes 2132 ng/ml with a 70% sensitivity and 82.4% specificity with AUC 0.821, standard error 0.085 and 95% CI of 0.65-0.98. Multivariate logistic regression shows baseline platelet counts &amp;lt; 50000 cells/uL [OR 4.7, p=0.02, 95% CI 1.19-18.54] and Albumin &amp;lt; 3.5 gm/dL [OR 6.33 p=0.007 95% CI 1.67-24.06] to be independent predictors of severe dengue. Day 0 ferritin level &amp;gt; 9185ng/mL gave an Odd’s ratio of 10.47 with p=0.052 and 95% CI [0.98-112]. Correlation of ferritin with various biochemical parameters and Ferritin cutoff value to differentiate Severe from Non severe dengue by ROC curve Table 3 and Figure 10 Scatter plot showing strong positive correlation between serum ferritin and SGOT/ SGPT levels, and negative correlation with serum albumin level .Figure 11 ROC curve analysis showing the ferritin cutoff being 9185ng/ml to differentiate between severe and non severe dengue. If sample taken within day 7 of illness the cut off becomes 2132 ng/ml (Figure 12) Conclusion Ferritin can be a useful biomarker for differentiating different grades of dengue severity especially if sample taken in the 1st week of illness. Serum ferritin cut off values can be used to predict severe dengue. Multivariate Logistic regression to find independant predictor of severe Dengue Table 4 showing Multivariate logistic regression result, which reveals baseline platelet count &amp;lt;50000 and Albumin level &amp;lt;3.5gm/dL to be independent predictor of severe dengue.Day 0 Ferritin cutoff of 9185 ng/dL as per the ROC curve analysis shows that the Odds of prediction of severe dengue is 10.47 (p=0.052 and 95% CI 0.98-112). Disclosures All Authors: No reported disclosures

Prediction Model of the T Cell-mediated Rejection After Liver Transplantation in Children and Adults: a Case-controlled Study.

T cell-mediated rejection (TCMR) is a major concern following liver transplantation (LT), and identifying its predictors could help improve post-transplant prognosis. This study aimed to develop a model to predict the risk of TCMR in children and adults after LT. Pre-transplant demographic characteristics, intraoperative parameters, and especially early post-transplant laboratory data for 1,221 LT recipients (1,096 adults and 125 children) were obtained from Hospital, University, between 1 January 2015, and 1 January 2022. These data were analyzed to develop the prediction model. The incidence of TCMR was higher in pediatric LT recipients than in adults (17.6% vs. 6.4%, p < 0.001). In adult recipients, seven predictors were identified: donor sex, recipient age, recipient height, and post-transplant levels of serum direct bilirubin, urea, platelets, and neutrophil-to-lymphocyte ratio. In pediatric recipients, four predictors were identified: post-transplant levels of serum monocyte percentage, direct bilirubin, albumin, and gamma-glutamyl transferase. The area under the model's curve incorporating these variables for predicting TCMR after LT was 0.713 (95% CI: 0.655-0.770) in adults and 0.786 (95% CI: 0.675-0.896) in children. Decision curve analyses demonstrated the clinical significance of the model. This study developed a prediction model that may be useful in identifying high-TCMR-risk populations in both adult and pediatric LT recipients.